Transgender services in England are not big enough to deal with the number of people who need care, an inquest heard.

The second day of the inquest into the death of transgender woman Alice Litman, who took her own life on May 26, 2022, in Brighton, heard evidence from medical professionals involved in the 20-year-old’s care.

The inquest at Sussex County Cricket Ground in Hove heard there are currently more than 13,000 people on the waiting list for a first appointment at the Tavistock and Portman NHS Foundation Trust Gender Identity Clinic and that in some cases people have been waiting five years to see a professional.

At the time of Alice’s death, she had been waiting 1,023 days for gender affirming healthcare.

In a statement read out in court, Michael Webberley, a former physician who is a co-founder of Gender GP who met Alice in September 2019, said her parents reached out to him after she was referred to the Tavistock and Portman Foundation because the waiting list there was too long.

She was prescribed cross-sex hormones by the service in April 2020.

“We see so many people let down by the NHS,” he said.

“The extraordinarily long waiting list is causing severe mental health rates for trans people.

“The unacceptable suicide and self-harm rates in this group is a travesty.”

He added that Alice’s death was “preventable” and that the waiting list for transgender people to receive treatment should be “days and weeks – not decades”.

The court also heard from Dr Sam Hall from WellBN.

Alice registered with WellBN in April 2022 and had submitted an eConsult, a form-based online consultation and triage platform, which expressed she felt like “life was not worth living” and that she believed her hormone treatment was not being properly managed.

Dr Hall said suicidal feelings in the trans community and young people were “devastatingly common” and that much of this was due to “non acceptance of trans identities in wider society”.

Read more: Mother of transgender woman says daughter was 'failed' by healthcare system

Dr Hall said more GP surgeries should provide hormone prescriptions for transgender people.

“Trans care belongs in primary care,” he said.

“Not least because we can get to people first.”

He told the court that at an appointment with another doctor on May 13 for an ear problem Alice was “disappointed” that the appointment was not to do with her hormone prescription.

Dr Hall said there was a wait of eight to 12 weeks for these appointments where hormones would be thoroughly discussed.

However, he said Alice had told the doctor she was feeling better and had recently stopped taking her anti-depressants.

Dr Hall was asked about how trans people cope with setbacks in their transition.

“Some are extremely resilient and know exactly what they want and how to get it," he said.

“Looking in hindsight Alice did not have that level of resilience.”

When asked about referring Alice to mental health services, Dr Hall said if they had referred Alice following the contents of her eConsult this would have been rejected.

“A rejection would have been worse,” he said.

“There’s nowhere for these patients to go.”

The court finally heard from Dr James Barrett, director at the Tavistock and Portman NHS Foundation Trust, who said there would be no way for Alice to have been expedited to receive quicker care due to her mental state.

The doctor said if they expedited people based on factors including anxiety, depression, age, or suicide risks it would become a competition.

He said long waiting lists was a national issue and that clinics across the globe were seeing an increase in demand for care.

“We don’t want to get into making those judgements,” he said.

“There are very very many people with remarkably similar situations to Alice.

“The size of the population we’re dealing with, the services aren’t big enough.”

He said that young people moving from child to adult psychiatric services faced problems “across the board” and not just in the transgender community.

“The threshold to be seen by adult mental health services is very high,” he said.

The inquest continues.